68Ga-PSMA PET/CT in patients with recurrent prostate cancer after radical treatment: prospective results in 314 patients

  • Paola Caroli
  • Israel Sandler
  • Federica Matteucci
  • Ugo De Giorgi
  • Licia Uccelli
  • Monica Celli
  • Flavia Foca
  • Domenico Barone
  • Antonino Romeo
  • Anna Sarnelli
  • Giovanni PaganelliEmail author
Original Article



We studied the usefulness of 68Ga-prostate-specific membrane antigen (PSMA) PET/CT for detecting relapse in a prospective series of patients with biochemical recurrence (BCR) of prostate cancer (PCa) after radical treatment.


Patients with BCR of PCa after radical surgery and/or radiotherapy with or without androgen-deprivation therapy were included in the study. 68Ga-PSMA PET/CT scans performed from the top of the head to the mid-thigh 60 min after intravenous injection of 150 ± 50 MBq of 68Ga-PSMA were interpreted by two nuclear medicine physicians. The results were correlated with prostate-specific antigen (PSA) levels at the time of the scan (PSApet), PSA doubling time, Gleason score, tumour stage, postsurgery tumour residue, time from primary therapy to BCR, and patient age. When available, 68Ga-PSMA PET/CT scans were compared with negative 18F-choline PET/CT scans routinely performed up to 1 month previously.


From November 2015 to October 2017, 314 PCa patients with BCR were evaluated. Their median age was 70 years (range 44–92 years) and their median PSApet was 0.83 ng/ml (range 0.003–80.0 ng/ml). 68Ga-PSMA PET/CT was positive (one or more suspected PCa lesions detected) in 197 patients (62.7%). Lesions limited to the pelvis, i.e. the prostate/prostate bed and/or pelvic lymph nodes (LNs), were detected in 117 patients (59.4%). At least one distant lesion (LNs, bone, other organs, separately or combined with local lesions) was detected in 80 patients (40.6%). PSApet was higher in PET-positive than in PET-negative patients (P < 0.0001). Of 88 patients negative on choline PET/CT scans, 59 (67%) were positive on 68Ga-PSMA PET/CT.


We confirmed the value of 68Ga-PSMA PET/CT in restaging PCa patients with BCR, highlighting its superior performance and safety compared with choline PET/CT. Higher PSApet was associated with a higher relapse detection rate.


PSMA PET/CT Prostate cancer Biochemical recurrence PSA 



The authors thank Gráinne Tierney and Cristiano Verna for editorial assistance.

Author contributions

Conception and design: G.P., I.S., U.De G. and P.C.

Collection and assembly of data: P.C., F.M. and I.S.

Data analysis and interpretation: F.F., I.S. and P.C.

Manuscript writing: All authors.

Final approval of manuscipt: All authors.

Accountable for all aspects of the work: All authors.


This study was partially supported by the Italian Ministry of Health, grant RF-2016-02364230, and by the Italian Association for Cancer Research (AIRC), grant IG 20476.

Compliance with ethical standards

Conflicts of interest


Ethical approval

The protocol was approved by the Ethics Committee of Area Vasta Romagna and by the competent Italian regulatory authorities. The study was performed in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice.

Informed consent

All patients gave their written informed consent.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Paola Caroli
    • 1
  • Israel Sandler
    • 1
  • Federica Matteucci
    • 1
  • Ugo De Giorgi
    • 2
  • Licia Uccelli
    • 3
  • Monica Celli
    • 1
  • Flavia Foca
    • 4
  • Domenico Barone
    • 5
  • Antonino Romeo
    • 6
  • Anna Sarnelli
    • 7
  • Giovanni Paganelli
    • 1
    Email author
  1. 1.Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCSMeldolaItaly
  2. 2.Department of Medical OncologyIstituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCSMeldolaItaly
  3. 3.Morphology, Surgery and Experimental Medicine DepartmentUniversity of FerraraFerraraItaly
  4. 4.Biostatistics and Clinical Trials UnitIstituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCSMeldolaItaly
  5. 5.Radiology UnitIstituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCSMeldolaItaly
  6. 6.Radiotherapy UnitIstituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCSMeldolaItaly
  7. 7.Medical Physics UnitIstituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCSMeldolaItaly

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